Automatic Payment or Withdrawal authorization change.
(Use this form to change automatic payments or withdrawals such as loan payments, insurance payments, transfers to brokerage accounts and etc.)

Date:
To:

From:

Please accept this letter as authorization to change the bank account information for automatic payments or withdrawals in the name of ___________, customer account number __________, payment type ____________________, with the approximate amount of transfer of $ __________.
I am aware that some automatic deposits require advance notice of changes. Please consider those notice periods when determining the new effective date.
Effective immediately, the new bank information is as follows:

Friend Bank account number:
My new bank account number is:
______________________________
My new bank routing number is 062102221.
If available, attached is a voided check from my account.
If you have questions, please call me at ____________________. Please send me written confirmation of when the change will be effective. Thank you.
Sincerely, _____________________